Oxaliplatin
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Hypersensitivity reactions: 7 case reports In a retrospective, cohort study of 431 patients treated at French teaching hospital, between January 2016 and July 2018, 7 patients involving 4 men and 3 women aged 33–83 years were described, who developed hypersensitivity reactions (HSRs) during treatment with oxaliplatin for various types of cancers [routes, dosages and durations of treatments to reactions onsets not stated]. The patients, who had locally advanced oesophageal cancer (3 patients), metastatic oesophageal cancer (1 patient), metastatic colon cancer (2 patients) and metastatic stomach cancer (1 patient), received chemotherapy regimen with oxaliplatin and fluorouracil [5-fluorouracil; 4 patients], oxaliplatin along with fluorouracil and panitumumab (1 patient), oxaliplatin along with fluorouracil and bevacizumab (1 patient) and oxaliplatin along with fluorouracil and trastuzumab (1 patient). Out of these 7 patients, 1 patient had a known allergy to nickel. All the patients received oxaliplatin infusions ranging from 2–7. Oxaliplatin was solubilised in a single bag and was administered at a slower infusion rate (thereby delivering a lower oxaliplatin concentration), which was gradually increased over time for a total of 6h. Subsequently, the patients developed HSRs manifesting as grade 3 urticaria, dyspnoea and hypotension (1 patient), grade 2 rash (1 patient), grade 2 rash and pruritus (1 patient), grade 2 rash, pruritus and dyspnoea (1 patient), grade 1 pruritus (1 patient), grade 2 rash and urticaria (1 patient) and grade 2 dyspnoea (1 patient). Out of these 7 patients, 6 patients underwent skin testing, which was found to be positive in 3 patients and negative in 3 patients. Subsequently, all the patients underwent desensitisationprotocol and received oxaliplatin infusions ranging from 1–5 infusions. Prior to desensitisation, all the patients were pre-medicated with dexchlorpheniramine [Polaramine] 48h, 24h and 30 minutes prior to the procedure as antihistaminergic therapy and methylprednisolone [Solumedrol] 2.5h prior to the procedure as corticosteroid therapy. Of these 7 patients, 3 patients developed recurrent grade 1–3 HSRs post-desensitisation. Out of these 7 patients, 4 patients were re-treated with conventional oxaliplatin infusions ranging from 1–6 infusions and treatment was changed in 3 patients. The patients, who were re-treated with conventional oxaliplatin, one patient received oxaliplatin infusion over 2h and the other 3 patients received oxaliplatin infusion for 6h. Out of 3 patients who received oxaliplatin infusion for 6h, 2 patients had progressive disease and 1 patient had neurosensitivity despite successful retreatment. Author comment: "This study was undertaken to assess the safety and feasibility of an oxaliplatin-desensitization procedure in an outpatient cancer unit in France." "Oxaliplatin-based regimens have dramatically improved the treatment of gastrointestinal cancers but oxaliplatin induced hypersensitivity reactions (HSRs) are unpredictable and can lead to permanent t
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